Transthoracic intracardiac monitoring lines in pediatric surgical patients: a ten-year experience.

A study of 6,690 transthoracic intracardiac monitoring (TIM) catheters in 5,666 pediatric patients undergoing cardiac surgical procedures during a 10-year period demonstrates the safety of this monitoring method. The utility of TIM catheters in patients undergoing a modified Fontan procedure, those undergoing repair of tetralogy of Fallot, and those with elevated or labile pulmonary resistance is stressed. Right atrial (RA) and left atrial (LA) catheters are particularly safe; they have a low incidence of bleeding complications (RA = 0%, LA = 0.13%) and retention complications (RA = 0.15%, LA = 0.63%). Pulmonary artery (PA) catheters that are introduced through the right ventricular infundibulum have higher complication rates (1.07%); unpredictable hemodynamic compromise occurs in approximately 0.5% of such patients. PA catheters placed through the wall of the atrium have a lower complication rate-approximately equal to that for RA and LA catheters. The benefits of TIM catheters far outweight the associated risks if care is exercised in placing and removing them, and if complications are rapidly recognized and aggressively managed. The continued use of TIM catheters in pediatric cardiac surgical patients is therefore strongly recommended.